The Social Side of Service Accessibility

Abstract:
This methodological project relates both to the conceptualization and measurement of potential program effects. The starting point is the hypothesis that the social side of service accessibility--i.e., social network characteristics that affect access to information and redundancy in the information obtained--is important to an understanding of accessibility and its effects. Our results suggest that this is true. Using a unique survey data set for Nang Rong, Thailand, we formalize social network concepts at the individual and village level, and then examine effects on contraceptive choice--method and source--in the context of models that also take into account physical proximity. To quickly summarize our results: Proximity to family planning outlets affected contraceptive choices, especially source choices. Women living further away from a local health center were less likely to choose a local health center, and women living further away from a hospital were less likely to choose a hospital. Proximity mattered less, however, for women living in households directly linked by sibling ties to other households in the village and to siblings living in other places. Results inform the design and interpretation of evaluation efforts in a variety of settings, and the potential role of social networks in bringing about program effects. While the specific focus is the provision of family planning services, the idea extends to the provision of STD or maternal and child health services as well.

MEASURE Evaluation is funded by USAID to strengthen capacity in developing countries to gather, interpret,
and use data to improve health. We create tools and approaches for rigorous evaluations, providing evidence to address
health challenges. And we strengthen health information systems so countries can make better decisions and sustain good health
outcomes over time.

MEASURE Evaluation is funded by the United States Agency for International Development (USAID) and the
U.S. President's Emergency Plan for AIDS Relief (PEPFAR). The information provided on this web
site is not official U.S. government information and does not necessarily represent the views of USAID, PEPFAR or the U.S. government.